Antiepileptic Drug Choice: Patient vs Neurologist

Neurologists and patients with epilepsy had similar antiepileptic drug (AED) preferences, according to results of a national survey. The survey also explored what particular AED attributes epilepsy patients most prefer. Fulton Velez, MD, Director of Health Economics and Outcomes Research at Sunovion Pharmaceuticals Inc., presents study findings.

Epilepsy patients (≥18 years, treated with AEDs) and neurologists were recruited from nationally representative US panels to complete an online survey that included a discrete choice experiment component (DCE). Participants were asked to rank 13 AED attributes based on their relative influence on prescribing/treatment decisions. For the DCE portion, participants viewed 15 hypothetical AED sets and selected an AED from each set based on hypothetical profiles related to efficacy, adverse effects (AEs), and convenience.

A total of 805 participants were analyzed (603 epilepsy patients, 152 general neurologists, and 50 epileptologist-neurologists). Both patients and neurologists were unanimous in their selection of the five most important AED attributes: seizure control; problems with memory, attention, or thought clarity; problems with coordination, balance, or falling; problems with feeling fatigued, sleepy, or drowsy; and the risk of developing depression, irritability, or anxiety. Patients with incomplete seizure control ranked all AED attributes significantly higher than the overall patient population and ranked seven of the 13 attributes significantly higher than neurologists did.

According to results of the DCE, much of the treatment preference for neurologists and patients (63% and 49%, respectively) was influenced by two variables: seizure control (45% of overall influence and 32%, respectively) and number of AED pills taken daily (18% and 17%, respectively). Patients also included a third important attribute that influenced their decision-making: the risk of developing psychiatric issues (depression, anxiety, or irritability) (20% influence).

The results of this study further reinforce the importance of considering patient preferences when making AED treatment decisions.

Reference: Ettinger A, et al. Comparing Anti-Epileptic Drug Preferences Between Neurologists and Patients: Results from a National Survey and Discrete Choice Experiment. Poster presentation P5.009, Apr 20, 2016. AAN Annual Meeting, Vancouver, British Columbia.